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Practical Guidelines for Spinal Stereotactic Body Radiation Therapy Posttreatment Follow-Up: Empirical Consensus From
François Fabi1, Mélanie Gaudreault2, Mathieu Leclerc2
1Service de radio-oncologie, Département de médecine spécialisée, Centre intégré de cancérologie (CIC), Hôpital de l'Enfant-Jésus, Centre Hospitalier Universitaire (CHU) de Québec, Université Laval, Québec City, Québec, Canada.
New guidelines offer risk-stratified follow-up for spinal stereotactic body radiotherapy (SBRT) patients, adapting imaging to clinical needs and resource availability. This approach optimizes surveillance for metastatic spine disease, reducing unnecessary scans and conserving healthcare resources.
Area of Science:
- Oncology
- Radiation Oncology
- Radiology
Background:
- Spinal stereotactic body radiotherapy (SBRT) offers durable local control for metastatic spine disease.
- Post-treatment surveillance is crucial but challenging due to limited magnetic resonance imaging (MRI) access in some healthcare systems.
- Current calendar-based imaging guidelines are difficult to implement in resource-constrained environments.
Purpose of the Study:
- To develop practical, risk-stratified follow-up guidelines for post-SBRT surveillance.
- To ensure feasibility across province-wide oncology centers with varying resource availability.
- To adapt surveillance strategies to real-world clinical workflows and MRI access limitations.
Main Methods:
- A modified Nominal Group Technique was employed with seven radiation oncologists from four SBRT-providing centers.
- Panelists reviewed literature on imaging surveillance and contributed center-specific considerations.
- Recommendations were iteratively refined, with consensus defined by predefined thresholds (≥80% strong, 60-79% moderate).
Main Results:
- Initial round yielded strong consensus on 11/19 statements, moderate on 5, with 3 failing to meet the threshold.
- Following refinement, all 18 remaining statements achieved strong consensus in Round 2.
- Key themes included: anchoring imaging to clinical intent, prioritizing MRI for feasible salvage therapy, de-escalating surveillance for low-risk/progressing patients, tailoring modality to resources, and integrating tumor-specific pathways (e.g., prostate cancer).
Conclusions:
- Consensus-derived guidelines provide a pragmatic surveillance strategy for spine SBRT, balancing clinical needs with resource realities.
- Risk-adapted imaging reduces unnecessary investigations, preserves resources, and focuses surveillance on impactful interventions.
- The framework is broadly applicable to settings with similar constraints, though prospective validation is warranted.
